Provider Demographics
NPI:1710240965
Name:PUZEVICH, VICTOR ALEKSEYEVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ALEKSEYEVICH
Last Name:PUZEVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 CAPRICORN WAY UNIT 89
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1878
Mailing Address - Country:US
Mailing Address - Phone:858-635-9445
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DRIVE
Practice Address - Street 2:NEUROSURGEONS FOR CHILDREN
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-456-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
05944772282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren